Digital and Coaching Interventions for Uptake of Cancer Genetic Testing: The MiGHT Randomized Clinical Trial

IMPORTANCE: Germline genetic testing (GT) for hereditary cancer risk can inform cancer treatment, screening, and prevention, yet testing rates remain low. Alternative strategies are needed to improve facilitation of GT. OBJECTIVE: To compare 2 patient-level interventions to increase uptake of hereditary cancer GT against usual care. DESIGN, SETTING, AND PARTICIPANTS: The Michigan Genetic Hereditary Testing (MiGHT) randomized clinical trial analyzed self-reported GT outcome data from participants meeting clinical GT criteria between April 21, 2022, and November 21, 2025. Participants were adults (age ≥18 years) who met national criteria for genetic evaluation and had not previously completed germline GT recruited from oncology, primary care, and gastroenterology practices; research registries; and the general public in Michigan. Data were analyzed from April 30, 2025, to May 1, 2026. INTERVENTIONS: Participants were randomized to either telephone-based health coaching, a self-directed digital intervention, or usual care. Both interventions incorporated genetics education and motivational interviewing concepts. MAIN OUTCOMES AND MEASURES: GT uptake was assessed at 6- and 12-month time points. The primary outcome was completion of GT by 6 months. The effects of study group on GT uptake were evaluated using logistic regression, adjusting for cancer history, age, gender, and race. RESULTS: A total of 793 participants (median [IQR] age, 64 [51-71] years; 458 [57.8%] female) were randomized to health coaching (261 participants), the digital intervention (265 participants), or usual care (267 participants). Overall, 31 participants (4.9%) reported completing GT by the 6-month time point, and 76 participants (9.6%) underwent GT across the 12-month study period. Compared with usual care, participants in the digital intervention group had higher odds of completing GT by 6 months (adjusted odds ratio [AOR], 3.88; 97.5% CI, 1.27-14.80), while those in the health coaching group had higher odds of completing GT by 12 months (AOR, 2.25; 97.5% CI, 1.11-4.77). Participants in the digital intervention group were more likely to express intention to test at 6 months (AOR, 2.36; 95% CI, 1.44-3.93), whereas those in the health coaching group had higher intention at both 6 (AOR, 2.99; 95% CI, 1.83-4.95) and 12 (AOR, 2.29; 95% CI 1.29-4.15) months compared with usual care. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of GT interventions, GT uptake was higher among participants who received the digital or health coaching interventions compared with usual care, although overall testing rates were low. These results underscore the importance of content delivery, motivational messaging, and alternative GT care models. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05162846.